<!--# layout("/common/layout.html",{"jsBase":"/js/cms/greenTreatment/"}){ -->

<form class="layui-form " id="addForm" AUTOCOMPLETE="OFF">
    <!--# include("/cms/common/basic.html",{"basic":essentialInformation}){} -->
    <fieldset class="layui-elem-field">
        <legend>直系亲属信息</legend>
        <div class="layui-row">
            <div class="layui-form-item">
                <div class="layui-inline">
                    <label class="layui-form-label">姓名<span style="color: red">*</span></label>
                    <div class="layui-input-inline">
                        <input type="text" id="relativesName" name="relativesName" lay-verify="required"  class="layui-input">
                    </div>
                </div>
                <div class="layui-inline">
                    <label class="layui-form-label">性别<span style="color: red">*</span></label>
                    <div class="layui-input-inline">
                        <layui:simpleDictSelect style='layui-input-inline' type="gender"
                                                id="relativesSex" name="relativesSex"
                                                layVerify="required" lay-filter="relativesSex"/>
                    </div>
                </div>
            </div>
        </div>
        <div class="layui-row">
            <div class="layui-form-item">
                <div class="layui-inline">
                    <label class="layui-form-label">工作单位<span style="color: red">*</span></label>
                    <div class="layui-input-inline">
                        <input type="text" id="relativesWork" name="relativesWork" lay-verify="required"  class="layui-input">
                    </div>
                </div>
                <div class="layui-inline">
                    <label class="layui-form-label">联系电话<span style="color: red">*</span></label>
                    <div class="layui-input-inline">
                        <input type="text" id="relativesIphone" name="relativesIphone" lay-verify="required"  class="layui-input">
                    </div>
                </div>
            </div>
        </div>
        <div class="layui-row">
            <div class="layui-form-item">
                <div class="layui-inline">
                    <label class="layui-form-label">国籍<span style="color: red">*</span></label>
                    <div class="layui-input-inline">
                        <input type="text" id="relativesNationality" name="relativesNationality" lay-verify="required"  class="layui-input">
                    </div>
                </div>
                <div class="layui-inline">
                    <label class="layui-form-label">身份证号<span style="color: red">*</span></label>
                    <div class="layui-input-inline">
                        <input type="text" id="relativesIdCard" name="relativesIdCard" lay-verify="required"  class="layui-input">
                    </div>
                </div>
            </div>
        </div>
        <div class="layui-row">
            <div class="layui-form-item">
                <div class="layui-inline">
                    <label class="layui-form-label">特殊情况说明(最多100汉字)</label>
                    <div class="layui-input-inline">
                        <textarea id="specialInstructions" name="specialInstructions"   class="layui-textarea" style="width: 740px" maxlength="200"></textarea>
                    </div>
                </div>
            </div>
        </div>
    </fieldset>
    <layui:personnelsubmitButtons id="addButton" />
</form>
<!--#} -->
<script>
    layui.use(['add'], function(){
        var greenTreatmentAdd = layui.add
        greenTreatmentAdd.init();
    });
</script>
